Brief communication: Fatal human metapneumovirus infection in stem-cell transplant recipients
Brief communication: Fatal human metapneumovirus infection in stem-cell transplant recipients
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DOI：
10.7326/0003-4819-144-5-200603070-00010
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发表时间：
2006-03-07
影响因子：
39.2
通讯作者：
Corey, L
中科院分区：
文献类型：
--
作者：
Englund, JA;Boeckh, M;Corey, L
背景：人偏肺病毒（hMPV）是最近发现的一种呼吸道病毒，与年轻人和老年人的临床疾病相关。目的：确定 hMPV 在造血干细胞移植受者中的重要性。设计：对连续残留支气管肺泡灌洗（BAL）样本的患者进行回顾性调查。地点：转诊癌症中心。患者： 因下呼吸道疾病而接受 BAL 的造血干细胞移植受者。测量：采用实时定量聚合酶链反应方法对支气管肺泡灌洗标本进行检测。结果：163 名患者中有 5 名 (3.0%) 的 BAL 标本中检测到人偏肺病毒。在 3 名患者的多个样本中发现了持续的病毒感染，并且在所测试的 2 个肺样本中的 1 个中检测到了 hMPV。受感染的患者在移植后 40 天内出现症状。最初的症状包括发烧、咳嗽、鼻塞和喉咙痛。临床结果包括呼吸衰竭、肺出血和培养阴性感染性休克。 5 名患者中有 4 人死于急性呼吸衰竭。 局限性：这项回顾性研究没有评估无症状患者或病情较轻的患者。结论：下呼吸道人类偏肺病毒感染与免疫功能低下成人的呼吸衰竭有关，这些人以前被认为患有“特发性肺炎”。感染可能导致移植后爆发性呼吸代偿失调和休克。
Background: Human metapneumovirus (hMPV), a recently discovered respiratory virus, is associated with clinical disease in young and elderly persons.Objective: To determine the importance of hMPV in hematopoietic stem-cell transplant recipients.Design: Retrospective survey of patients with consecutive residual bronchoalveolar lavage (BAL) samples.Setting: Referral cancer center.Patients: Hematopoietic stem-cell transplant recipients who underwent BAL because of lower respiratory tract disease.Measurements: Bronchoalveolar lavage specimens were assayed by quantitative real-time polymerase chain reaction methods.Results: Human metapneumovirus was detected in BAL specimens from 5 of 163 patients (3.0%). Persistent viral infection was noted in 3 patients with several samples, and hMPV was detected in 1 of 2 lung specimens tested. Infected patients became symptomatic within the first 40 days after transplantation. Initial symptoms included fever, cough, nasal congestion, and sore throat. Clinical findings included respiratory failure, pulmonary hemorrhage, and culture-negative septic shock. Four of 5 patients died with acute respiratory failure.Limitations: This retrospective study did not evaluate asymptomatic patients or those with mild disease.Conclusion: Human metapneumovirus infection in the lower respiratory tract is associated with respiratory failure in immunocompromised adults who were previously considered to have "idiopathic pneumonia." The infection may result in fulminant respiratory decompensation and shock after transplantation.